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RUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT I I I I I I I I I I <br /> Page 1 of 2 Refer to Instruction Pamphtel STATE WELL NO./STATION NO. <br /> Owner's Well No. 95336 NO.e0336553 ❑ <br /> Date Work Began 2/13/2017 Ended2/27/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health _ _ _ __ 1_ I 1 1 1 1 1 1 1 1- <br /> Permit <br /> _ <br /> 765504 12/28/2016 APNrrRS/OTHER <br /> Permit No. Permit Date _ <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Harold Van Rys <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address.13293 E. Louise Ave <br /> URFACE –1 DESCRIPTION Manteca CA 95336 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITE' STATE ZIP <br /> 0 3 Top Soil Address 13293 E. Louie AVeL LOCATION <br /> 3 22 Clay City Manteca CA 95336 <br /> 22 28 Sand County San Joaquin <br /> 28 60 Clay APN Book Page Parcel <br /> 60 80 Sand Township Range Section <br /> 80 116 Clay Latitude 1 1 1 <br /> 116 148 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 148 169 Clay LOCATION SKETCH ACTIVITY (v) <br /> NORTH -/ NEW WELL <br /> 169 173 Sand <br /> 173 177 Clay MODIFICATION/REPAIR <br /> —Deepen <br /> 177 188 Sand —other(Specify) <br /> 188 2071 Clay <br /> — <br /> DESTROY(Describe <br /> 207 210 Shale Procedures and Materials <br /> 210224 Clay Under"GEOLOGIC LOG' <br /> 224 225 Sand PLANNED USES() <br /> WATER SUPPLY <br /> 225 232 Clay 2/~i y Domestic_ Public <br /> 232 233 Sand –tL Irrigation _ Industrial <br /> 233 247 Clay MONITORING— <br /> TEST WELL— <br /> 247 251 Sand ATHODIC PROTECTION- <br /> 251 258 Clay HEAT EXCHANGE- <br /> 258 264 Sand DIRECT PUSH_ <br /> 264 274 Clay INJECTION— <br /> TRACTION— <br /> VAPOR EX <br /> 274 281 Shale SPARGING_ <br /> 281 314 Clay SOUTH REMEDIATION_ <br /> 314 316 Sand Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> 316 327 Shale necemiry.PLEASE BE ACCURATE & COMPLETE. <br /> 327 344 Clay WATER LEVEL&YIELD OF COMPLETED WELL <br /> 344 345 Sand DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 345 368 Shale DEPTH OF STA <br /> 368 372 Sand WATER LEVEL (Ft.)&DATE MEASURED 2/21/2017 <br /> TOTAL DEPTH OF BORING 450 ESTIMATED YIELD • (GPM)& TEST TYPE _. <br /> (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL 440 (Feet) (Hrs.) TOTAL DRAWDOWN (FL) <br /> M not be re resentative o a well's!on -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE 3TYPE -2-L) FROM SURFACE PE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZEE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> 0 360 2021 ASTIC 12 200 <br /> 0 50 360 380 45 RAVEL <br /> 380 400 <br /> 400 440 <br /> ATTACHMENTS (�) CERTIFICATION STATEMENT <br /> Geologic Log I.the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> Well Construction Diagram NAME MASELLIS DRILLING I IC <br /> Geophysical Log(s) (PERSON,go"– <br /> RINTED) <br /> Soit/Water Chemical Analysis 119Albers A 95 7 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed02/27/17 668622 <br /> WELL DRILLER/AUTHORI REPRES TATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 189 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />